Provider Demographics
NPI:1912100116
Name:FULLER, ASHLEY E (MD)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:E
Last Name:FULLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:633 YESLER WAY FL 3
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-2725
Mailing Address - Country:US
Mailing Address - Phone:206-866-5148
Mailing Address - Fax:
Practice Address - Street 1:1101 MADISON ST STE 1270
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-3554
Practice Address - Country:US
Practice Address - Phone:206-866-5148
Practice Address - Fax:888-775-6355
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WAMD60141979207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0040FUOtherREGENCE
WA1912100116Medicaid
WA264816OtherLNI
BP1-0026450OtherINSTITUTIONAL PERMIT
WA1912100116Medicaid